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Li H, Yuan S, Dai L, Huang H, Lin Z, Zhan S, Luo J, Liu W, Sun B. Anterior Capsulotomy for Refractory Obsessive-Compulsive Disorder: A Tractography and Lesion Geometry study. Stereotact Funct Neurosurg 2023; 101:407-415. [PMID: 37926091 DOI: 10.1159/000534312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION A bilateral anterior capsulotomy effectively treats refractory obsessive-compulsive disorder (OCD). We investigated the geometry of lesions and disruption of white matter pathways within the anterior limb of the internal capsule (ALIC) in patients with different outcomes. METHODS In this retrospective study, we analyzed data from 18 patients with refractory OCD who underwent capsulotomies. Patients were grouped into "responders" and "nonresponders" based on the percentage of decrease in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) after surgery. We investigated neurobehavioral adverse effects and analyzed the overlap between lesions and the ventromedial prefrontal (vmPFC) and dorsolateral prefrontal (dlPFC) pathways. Probabilistic maps were constructed to investigate the relationship between lesion location and clinical outcomes. RESULTS Of the 18 patients who underwent capsulotomies, 12 were responders (>35% improvement in YBOCS), and six were nonresponders. The vmPFC pathway was more involved than the dlPFC pathway in responders (p = 0.01), but no significant difference was observed in nonresponders (p = 0.10). The probabilistic voxel-wise efficacy map showed a relationship between ventral voxels within the ALIC with symptom improvement. Weight gains occurred in 11/18 (61%) patients and could be associated with medial voxels within the ALIC. CONCLUSION The optimal outcome after capsulotomy in refractory OCD is linked to vmPFC disruption in the ALIC. Medial voxels within the ALIC could be associated with weight gains following capsulotomy.
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Affiliation(s)
- Hongyang Li
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,
| | - Siyu Yuan
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Lulin Dai
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Huang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikun Zhan
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Luo
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Liu
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhao YJ, Zhang Y, Wang Q, Manssuer L, Cui H, Ding Q, Sun B, Liu W, Voon V. Evidence Accumulation and Neural Correlates of Uncertainty in Obsessive-Compulsive Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:1058-1065. [PMID: 37343660 PMCID: PMC10555851 DOI: 10.1016/j.bpsc.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/19/2023] [Accepted: 05/19/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Decision making is frequently associated with risk taking under uncertainty. Elevated intolerance of uncertainty is suggested to be a critical feature of obsessive-compulsive disorder (OCD). However, impairments of latent constructs of uncertainty processing and its neural correlates remain unclear in OCD. METHODS In 83 participants (24 OCD patients treated with capsulotomy, 28 OCD control participants, and 31 healthy control participants), we performed magnetic resonance imaging using a card gambling task in which participants made decisions whether to bet or not that the next card would be larger than the current one. A hierarchical drift diffusion model was used to dissociate speed and amount of evidence accumulated before a decisional threshold (i.e., betting or no betting) was reached. RESULTS High uncertainty was characterized by a smaller amount of evidence accumulation (lower thresholds), thus dissociating uncertainty from conflict tasks and highlighting the specificity of this task to test value-based uncertainty. OCD patients exhibited greater caution with poor performance and greater evidence accumulation overall along with slower speed of accumulation, particularly under low uncertainty. Bilateral dorsal anterior cingulate and anterior insula distinguished high- and low-uncertainty decision processes in healthy control participants but not in the OCD groups, indicating impairments in anticipation of differences in outcome variance and salience network activity. There were no behavioral or imaging differences relating to capsulotomy despite improvements in OCD symptoms. CONCLUSIONS Our findings highlight greater impairments particularly in more certain trials in the OCD groups along with impaired neural differentiation of high and low uncertainty and suggest uncertainty processing as a trait cognitive endophenotype rather than a state-specific factor.
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Affiliation(s)
- Yi-Jie Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China; Zhangjiang Fudan International Innovation Center, Shanghai, China; Department of Psychological Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yingying Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China; Zhangjiang Fudan International Innovation Center, Shanghai, China
| | - Qianfeng Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China; Zhangjiang Fudan International Innovation Center, Shanghai, China
| | - Luis Manssuer
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Hailun Cui
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Qiong Ding
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Clinical Neuroscience Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjuan Liu
- Department of Psychological Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Valerie Voon
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China; Zhangjiang Fudan International Innovation Center, Shanghai, China; Department of Psychological Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
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3
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Cui H, Zhang Y, Zhao Y, Zhao Y, Ding Q, Chen R, Manssuer L, Zhang C, Liu W, Li D, Sun B, Voon V. Mechanisms underlying capsulotomy for refractory obsessive-compulsive disorder: neural correlates of negative affect processing overlap with deep brain stimulation targets. Mol Psychiatry 2023; 28:3063-3074. [PMID: 36878966 PMCID: PMC10615758 DOI: 10.1038/s41380-023-01989-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 03/08/2023]
Abstract
Ablative procedures such as anterior capsulotomy are potentially effective in refractory obsessive-compulsive disorder (OCD). Converging evidence suggests the ventral internal capsule white matter tracts traversing the rostral cingulate and ventrolateral prefrontal cortex and thalamus is the optimal target for clinical efficacy across multiple deep brain stimulation targets for OCD. Here we ask which prefrontal regions and underlying cognitive processes might be implicated in the effects of capsulotomy by using both task fMRI and neuropsychological tests assessing OCD-relevant cognitive mechanisms known to map across prefrontal regions connected to the tracts targeted in capsulotomy. We tested OCD patients at least 6 months post-capsulotomy (n = 27), OCD controls (n = 33) and healthy controls (n = 34). We used a modified aversive monetary incentive delay paradigm with negative imagery and a within session extinction trial. Post-capsulotomy OCD subjects showed improved OCD symptoms, disability and quality of life with no differences in mood or anxiety or cognitive task performance on executive, inhibition, memory and learning tasks. Task fMRI revealed post-capsulotomy decreases in the nucleus accumbens during negative anticipation, and in the left rostral cingulate and left inferior frontal cortex during negative feedback. Post-capsulotomy patients showed attenuated accumbens-rostral cingulate functional connectivity. Rostral cingulate activity mediated capsulotomy improvement on obsessions. These regions overlap with optimal white matter tracts observed across multiple stimulation targets for OCD and might provide insights into further optimizing neuromodulation approaches. Our findings also suggest that aversive processing theoretical mechanisms may link ablative, stimulation and psychological interventions.
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Affiliation(s)
- Hailun Cui
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Yingying Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Neural and Intelligence Engineering Centre, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Yijie Zhao
- Neural and Intelligence Engineering Centre, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Ying Zhao
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Qiong Ding
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Ruiqin Chen
- Neural and Intelligence Engineering Centre, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Luis Manssuer
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjuan Liu
- Department of Psychological Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
- Neural and Intelligence Engineering Centre, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom.
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4
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Laseca-Zaballa G, Lubrini G, Periañez JA, Simón-Martínez V, Martín Bejarano M, Torres-Díaz C, Martínez Moreno N, Álvarez-Linera J, Martínez Álvarez R, Ríos-Lago M. Cognitive outcomes following functional neurosurgery in refractory OCD patients: a systematic review. Neurosurg Rev 2023; 46:145. [PMID: 37351641 PMCID: PMC10289910 DOI: 10.1007/s10143-023-02037-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 04/26/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023]
Abstract
Neurosurgery is a therapeutic option for patients with refractory obsessive-compulsive disorder who do not respond to previous treatments. Although its efficacy in reducing clinical symptomatology has been proven, few studies have analyzed its effects at the cognitive level. The aim of this systematic review was to describe the cognitive outcomes of functional neurosurgery in patients that went through capsulotomies or cingulotomies. PubMed, Medline, Scopus, PsycInfo, PsyArticles, and Web of Knowledge were searched for studies reporting cognitive outcomes in refractory obsessive-compulsive patients after capsulotomies and cingulotomies. The risk of bias was assessed with the Assessment Tool for Before-After (Pre-Post) Studies With No Control Group tool; 13 studies met inclusion criteria, including 205 refractory obsessive-compulsive disorder patients for both surgical procedures. Results showed a substantial number of studies that did report significant cognitive improvement after surgery, being this improvement specially related to memory and executive functions. The second-most frequent finding is the maintenance of cognitive performance (nor improvement or worsening). From a neuropsychological point of view, this outcome might be considered a success, given that it is accompanied by amelioration of obsessive-compulsive symptoms. Subtle cognitive adverse effects have also been reported. Neurosurgery procedures appear to be safe from a cognitive point of view. Methodological issues must be improved to draw clearer conclusions, but capsulotomies and cingulotomies constitute an effective alternative treatment for refractory obsessive-compulsive disorder patients.
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Affiliation(s)
- G Laseca-Zaballa
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Complutense University of Madrid, Madrid, Spain
| | - G Lubrini
- Department of Basic Psychology II, UNED, Madrid, Spain
| | - J A Periañez
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Complutense University of Madrid, Madrid, Spain
| | | | - M Martín Bejarano
- Neuropsychology Service, Fidias Health & Sport, Cádiz, Spain
- Faculty of Medicine, University of Cádiz, Cádiz, Spain
| | - C Torres-Díaz
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - N Martínez Moreno
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - J Álvarez-Linera
- Department of Radiodiagnosis, Ruber International Hospital, Madrid, Spain
| | - R Martínez Álvarez
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - M Ríos-Lago
- Department of Basic Psychology II, UNED, Madrid, Spain.
- Brain Damage Service, Beata Maria Ana Hospital, Madrid, Spain.
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5
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McLaughlin NCR, Magnotti JF, Banks GP, Nanda P, Hoexter MQ, Lopes AC, Batistuzzo MC, Asaad WF, Stewart C, Paulo D, Noren G, Greenberg BD, Malloy P, Salloway S, Correia S, Pathak Y, Sheehan J, Marsland R, Gorgulho A, De Salles A, Miguel EC, Rasmussen SA, Sheth SA. Gamma knife capsulotomy for intractable OCD: Neuroimage analysis of lesion size, location, and clinical response. Transl Psychiatry 2023; 13:134. [PMID: 37185805 PMCID: PMC10130137 DOI: 10.1038/s41398-023-02425-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 02/27/2023] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) affects 2-3% of the population. One-third of patients are poorly responsive to conventional therapies, and for a subgroup, gamma knife capsulotomy (GKC) is an option. We examined lesion characteristics in patients previously treated with GKC through well-established programs in Providence, RI (Butler Hospital/Rhode Island Hospital/Alpert Medical School of Brown University) and São Paulo, Brazil (University of São Paolo). Lesions were traced on T1 images from 26 patients who had received GKC targeting the ventral half of the anterior limb of the internal capsule (ALIC), and the masks were transformed into MNI space. Voxel-wise lesion-symptom mapping was performed to assess the influence of lesion location on Y-BOCS ratings. General linear models were built to compare the relationship between lesion size/location along different axes of the ALIC and above or below-average change in Y-BOCS ratings. Sixty-nine percent of this sample were full responders (≥35% improvement in OCD). Lesion occurrence anywhere within the targeted region was associated with clinical improvement, but modeling results demonstrated that lesions occurring posteriorly (closer to the anterior commissure) and dorsally (closer to the mid-ALIC) were associated with the greatest Y-BOCS reduction. No association was found between Y-BOCS reduction and overall lesion volume. GKC remains an effective treatment for refractory OCD. Our data suggest that continuing to target the bottom half of the ALIC in the coronal plane is likely to provide the dorsal-ventral height required to achieve optimal outcomes, as it will cover the white matter pathways relevant to change. Further analysis of individual variability will be essential for improving targeting and clinical outcomes, and potentially further reducing the lesion size necessary for beneficial outcomes.
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Affiliation(s)
- N C R McLaughlin
- Butler Hospital, Providence, RI, USA.
- Alpert Medical School of Brown University, Providence, RI, USA.
| | - J F Magnotti
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - G P Banks
- Columbia University Medical Center, New York, NY, USA
| | - P Nanda
- Columbia University Medical Center, New York, NY, USA
| | - M Q Hoexter
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - A C Lopes
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - M C Batistuzzo
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Department of Methods and Techniques in Psychology, Pontifical Catholic University, São Paulo, SP, Brazil
| | - W F Asaad
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | - C Stewart
- Boston University School of Public Health, Boston, MA, USA
| | - D Paulo
- Columbia University Medical Center, New York, NY, USA
| | - G Noren
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | - B D Greenberg
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
- Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - P Malloy
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
| | - S Salloway
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
| | - S Correia
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Y Pathak
- Columbia University Medical Center, New York, NY, USA
| | - J Sheehan
- University of Virginia, Charlottesville, VA, USA
| | | | - A Gorgulho
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - A De Salles
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - E C Miguel
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - S A Rasmussen
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | - S A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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6
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Kassel MT, Lositsky O, Vaidya AR, Badre D, Malloy PF, Greenberg BD, Marsland R, Noren G, Sherman A, Rasmussen SA, McLaughlin NC. Differential assessment of frontally-mediated behaviors between self- and informant-report in patients with obsessive-compulsive disorder following gamma ventral capsulotomy. Neuropsychologia 2022; 170:108211. [DOI: 10.1016/j.neuropsychologia.2022.108211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/02/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
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7
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Varinelli A, Caricasole V, Pellegrini L, Hall N, Garg K, Mpavaenda D, Dell'Osso B, Albert U, Fineberg NA. Functional interventions as augmentation strategies for obsessive-compulsive disorder (OCD): scoping review and expert survey from the international college of obsessive-compulsive spectrum disorders (ICOCS). Int J Psychiatry Clin Pract 2022; 26:92-107. [PMID: 33502269 DOI: 10.1080/13651501.2021.1872646] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with obsessive-compulsive disorder (OCD) commonly exhibit a range of functional difficulties, presumed linked to neurocognitive changes. Evidence-based first-line treatments have limited effect on improving these cognitive-functional problems. Candidate interventions could be used to augment evidence-based treatments by the multi-professional mental health team. METHODS A scoping review was performed to identify any intervention with at least one peer-reviewed report of clinical improvement in any of the 13 functional domains of the Cognitive Assessment Instrument of Obsessions and Compulsions (CAIOC-13). Next, an online survey of experts of the International College of Obsessive-Compulsive Spectrum Disorders was conducted. RESULTS Forty-four studies were identified reporting a positive outcome for 27 different kinds of intervention. Twenty-six experts from 12 different countries, including at least one expert from each continent, completed the opinion survey. Five interventions were identified as 'highly promising', none of which was moderated by rater-related factors, suggesting global applicability. CONCLUSION Patients with OCD may benefit from a detailed functional assessment, to identify areas of unmet need. A variety of interventions show theoretical promise for treating the complex functional difficulties in OCD as adjuncts to first-line treatments, but the published evidence is weak. Randomised controlled trials are needed to determine the clinical effectiveness of these interventions.HighlightsFunctional-cognitive problems are common in patients with OCD.First-line evidence-based treatments have limited effect on these functionalcognitive difficulties.In our scoping review we found 44 studies reporting of improved clinical outcomes in any of the 13 functional domains of the Cognitive Assessment Instrument of Obsessions and Compulsions (CAIOC-13).An online survey of experts of the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) was conducted and identified five interventions as "highly promising" candidate treatments for functional-cognitive problems in OCD.Randomised controlled trials are needed to determine the clinical effectiveness of these interventions.
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Affiliation(s)
- Alberto Varinelli
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco, University of Milan, Milan, Italy
| | - Valentina Caricasole
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco, University of Milan, Milan, Italy
| | - Luca Pellegrini
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Natalie Hall
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Kabir Garg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
| | - Davis Mpavaenda
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Bernardo Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA.,'Aldo Ravelli' Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy
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- International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) Expert Survey Workgroup: Michael Van Ameringen (Canada), Leonardo Fontenelle (Brazil), Giacomo Grassi (Italy), Jamie Feusner (US), Lior Carmi (Israel), Edna Grunblatt (Switzerland), Susanne Walitza (Switzerland), Christine Lochner (South Africa), Carolyn Rodriguez (US), Alexander Bystritsky (US), Maria Ceica Rosario (US), Peter van Roessel (US), Dan Geller (US), Eric Hollander (US), Humberto Nicolini (Mexico), Joseph Zohar (Israel), José Menchón (Spain)
| | - Naomi A Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
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8
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Satzer D, Mahavadi A, Lacy M, Grant JE, Warnke P. Interstitial laser anterior capsulotomy for obsessive-compulsive disorder: lesion size and tractography correlate with outcome. J Neurol Neurosurg Psychiatry 2022; 93:317-323. [PMID: 34716192 DOI: 10.1136/jnnp-2021-327730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anterior capsulotomy is a well-established treatment for refractory obsessive-compulsive disorder (OCD). MRI-guided laser interstitial thermal therapy (LITT) allows creation of large, sharply demarcated lesions with the safeguard of real-time imaging. OBJECTIVE To characterise the outcomes of laser anterior capsulotomy, including radiographical predictors of improvement. METHODS Patients with severe OCD refractory to pharmacotherapy and cognitive-behavioural therapy underwent bilateral anterior capsulotomy via LITT. The primary outcome was per cent reduction in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score over time. Lesion size was measured on postablation MRI. Disconnection of the anterior limb of the internal capsule (ALIC) was assessed via individual and normative tractography. RESULTS Eighteen patients underwent laser anterior capsulotomy. Median follow-up was 6 months (range 3-51 months). Time occupied by obsessions improved immediately (median Y-BOCS item 1 score 4-1, p=0.002). Mean (±SD) decrease in Y-BOCS score at last follow-up was 46%±32% (16±11 points, p<0.0001). Sixty-one per cent of patients were responders. Seven patients (39%) exhibited transient postoperative apathy. One patient had an asymptomatic intracerebral haemorrhage. Reduction in Y-BOCS score was positively associated with ablation volume (p=0.006). Individual tractography demonstrated durable ALIC disconnection. Normative tractography revealed a dorsal-ventral gradient, with disconnection of orbitofrontal streamlines most strongly associated with a positive response (p<0.0001). CONCLUSIONS Laser anterior capsulotomy resulted in immediate, marked improvement in OCD symptom severity. Larger lesions permit greater disconnection of prefrontal-subcortical pathways involved in OCD. The importance of greater disconnection is presumably related to variation in ALIC structure and the complex role of the PFC in OCD.
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Affiliation(s)
- David Satzer
- Neurosurgery, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Anil Mahavadi
- Neurosurgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maureen Lacy
- Psychaitry and Behavioral Neuroscience, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Jon E Grant
- Psychiatry, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Peter Warnke
- Neurosurgery, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
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9
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Simón-Martínez V, Laseca-Zaballa G, Lubrini G, Periáñez JA, Martínez Álvarez R, Torres-Díaz CV, Martínez Moreno N, Álvarez-Linera J, Ríos-Lago M. Cognitive deficits and clinical symptoms in patients with treatment-refractory obsessive-compulsive disorder: The role of slowness in information processing. Psychiatry Res 2021; 304:114143. [PMID: 34343878 DOI: 10.1016/j.psychres.2021.114143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/15/2021] [Accepted: 07/24/2021] [Indexed: 02/05/2023]
Abstract
Patients with Obsessive-Compulsive Disorder (OCD) present neuropsychological deficits across different cognitive domains, especially in executive functioning and information processing speed. Some studies have even suggested that speed deficits may underlie poor neuropsychological performance. However, this hypothesis remains unanswered in both OCD general population and OCD refractory subgroup. In addition, it is not clear whether such deficits are secondary to the clinical symptoms or may constitute a primary deficit. The aim of this study was to explore the speed of processing hypothesis in treatment-refractory OCD patients, and to clarify to what extent slowness is related to psychopathological symptoms. Both clinical and neuropsychological examination was conducted to assess 39 OCD refractory patients candidates for neurosurgery and 39 healthy matched individuals. Principal component analysis revealed a three-component structure in the neuropsychological battery being used, including a speed of processing, working memory, and conflict monitoring components. Group comparisons revealed that OCD patients performed significantly worse than healthy individuals in speed measures, but no differences were found in executive tests not influenced by time. Correlation analyses revealed a lack of association between neuropsychological and clinical measures. The results suggest that treatment-refractory OCD patients exhibit a primary deficit in information processing speed independent of clinical symptoms.
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Affiliation(s)
| | | | - Genny Lubrini
- Department Experimental Psychology, Complutense University of Madrid, Spain
| | - José A Periáñez
- Department Experimental Psychology, Complutense University of Madrid, Spain
| | - Roberto Martínez Álvarez
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - Cristina V Torres-Díaz
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - Nuria Martínez Moreno
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | | | - Marcos Ríos-Lago
- Department Basic Psychology II, UNED, Madrid, Spain; Brain Damage Service, Beata Maria Ana Hospital, Madrid, Spain.
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10
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Krámská L, Urgošík D, Liščák R, Hrešková L, Skopová J. Neuropsychological outcome in refractory obsessive-compulsive disorder treated with anterior capsulotomy including repeated surgery. Psychiatry Clin Neurosci 2021; 75:101-107. [PMID: 33368824 PMCID: PMC7986670 DOI: 10.1111/pcn.13190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 12/27/2022]
Abstract
AIM Anterior capsulotomy (AC) is one of the last therapeutic options for obsessive-compulsive disorder (OCD) refractory to conservative treatments. Several forms of cognitive dysfunction have been identified after assessment of neuropsychological outcomes in OCD patients; however, few studies focused on cognitive changes in OCD patients after surgery. In the present study, we evaluated the effects of AC on cognitive performance and mood status in patients with refractory OCD. METHODS A total of 12 patients underwent bilateral AC between 2012 and 2019 at our institution. The patients (n = 12, female : male 5:7; mean age 39.7 years; duration ≥5 years) were assessed before and 6 months after intervention. The diagnosis of treatment-refractory OCD was based on recommended criteria for surgical treatment. Patients were assessed using a neuropsychological battery and questionnaires focused on anxiety-depressive symptomatology. The Yale-Brown Obsessive Compulsive Scale was administered as a measure of severity of OCD symptoms. RESULTS We detected a significant decrease of OCD, and anxiety and depressive symptomatology assessed by Yale-Brown Obsessive Compulsive Scale, Beck Depression Inventory, and Beck Anxiety Inventory (P < 0.05) 6 months after AC in eight patients, and a partial decrease in four patients. Four patients underwent repeated AC with more pronounced improvement achieved after the first procedure. We did not detect decline in cognitive performance in any patients, but did find better visual memory performance (P < 0.05). CONCLUSION AC reduced OCD and anxiety-depressive symptoms, and did not appear to influence cognitive performance, even after repeated surgery.
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Affiliation(s)
- Lenka Krámská
- Department of Clinical Psychology, Na Homolce Hospital, Prague, Czech Republic.,Department of Neurology, Na Homolce Hospital, Prague, Czech Republic.,Charles University in Prague, Prague, Czech Republic
| | - Dušan Urgošík
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liščák
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Lucia Hrešková
- Department of Clinical Psychology, Na Homolce Hospital, Prague, Czech Republic
| | - Jaroslava Skopová
- Department of Psychiatry, Na Homolce Hospital, Prague, Czech Republic
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11
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Lai Y, Wang T, Zhang C, Lin G, Voon V, Chang J, Sun B. Effectiveness and safety of neuroablation for severe and treatment-resistant obsessive-compulsive disorder: a systematic review and meta-analysis. J Psychiatry Neurosci 2020; 45:356-369. [PMID: 32549057 PMCID: PMC7850151 DOI: 10.1503/jpn.190079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/05/2019] [Accepted: 01/16/2020] [Indexed: 11/01/2022] Open
Abstract
Background Several neuroablative procedures are available for severe and treatment-resistant obsessive-compulsive disorder (OCD), but limited knowledge about their relative clinical advantages and disadvantages poses obstacles for treatment decision-making. Methods We searched PubMed, Embase, Scopus, Web of Knowledge and the Cochrane Library for reports up to February 2019. We reviewed the literature on the effectiveness (assessed using the Yale-Brown Obsessive Compulsive Scale [Y-BOCS]) and safety of various neuroablative interventions for severe and treatment-resistant OCD. Results We included 23 studies involving 487 patients in the systematic review; 21 studies with 459 patients entered meta-analysis. Overall, neuroablation achieved a response rate (proportion of patients with ≥ 35% reduction in Y-BOCS) of 55%. Most of the adverse events (88.4%) were mild and transient. The top 3 adverse events were headache (14.9%), cognitive deficits (9.1%) and behaviour problems (8.1%). Severe or permanent adverse events included personality changes (2.3%) and brain edema or brain cyst (1.5%). The response rates associated with capsulotomy, limbic leucotomy and cingulotomy were 59% (95% confidence interval [CI] 54-65), 47% (95% CI 23-72) and 36% (95% CI 23-50), respectively. Interventions with different coverages of the dorsal part of the internal capsule were associated with different adverse-event profiles but were unlikely to modify clinical effectiveness. Limitations The level of evidence of most included studies was relatively low. Conclusion Ablative surgeries are safe and effective for a large proportion of patients with severe and treatment-resistant OCD. Among the available procedures, capsulotomy seemed to be the most effective. Further research is needed to improve clinical effectiveness and minimize risks.
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Affiliation(s)
- Yijie Lai
- From the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Lai, Wang, Zhang, Sun); the Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Lin); the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon); and the Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea (Chang)
| | - Tao Wang
- From the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Lai, Wang, Zhang, Sun); the Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Lin); the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon); and the Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea (Chang)
| | - Chencheng Zhang
- From the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Lai, Wang, Zhang, Sun); the Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Lin); the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon); and the Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea (Chang)
| | - Guozhen Lin
- From the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Lai, Wang, Zhang, Sun); the Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Lin); the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon); and the Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea (Chang)
| | - Valerie Voon
- From the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Lai, Wang, Zhang, Sun); the Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Lin); the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon); and the Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea (Chang)
| | - Jinwoo Chang
- From the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Lai, Wang, Zhang, Sun); the Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Lin); the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon); and the Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea (Chang)
| | - Bomin Sun
- From the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Lai, Wang, Zhang, Sun); the Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Lin); the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon); and the Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea (Chang)
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12
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Gupta A, Shepard MJ, Xu Z, Maiti T, Martinez-Moreno N, Silverman J, Iorio-Morin C, Martinez-Alvarez R, Barnett G, Mathieu D, Borghei-Razavi H, Kondziolka D, Sheehan JP. An International Radiosurgery Research Foundation Multicenter Retrospective Study of Gamma Ventral Capsulotomy for Obsessive Compulsive Disorder. Neurosurgery 2020; 85:808-816. [PMID: 30476294 DOI: 10.1093/neuros/nyy536] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/11/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) across its full spectrum of severity is a psychiatric illness affecting ∼2% to 3% of the general population and results in significant functional impairment. There are few large patient series regarding Gamma ventral capsulotomy (GVC). OBJECTIVE To evaluate clinical outcomes of severe medically refractory OCD treated with GVC. METHODS This is an international, multicenter, retrospective cohort study. Forty patients with pre-GVC Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores ≥ 24 (indicating severe OCD) were included. GVC was performed with 1 or 2 isocenters with a median maximum dose of 135 Gy (range, 120-180 Gy). Patients were deemed "responders" to GVC if there was ≥35% reduction of follow-up Y-BOCS scores, and considered in remission if their Y-BOCS scores were ≤16. The median follow-up was 36 mo (range, 6-96 mo). RESULTS The median pre-SRS Y-BOCS score was 35 (range, 24-40). Eighteen patients (45%) were considered "responders," and 16 (40%) of them were in remission at their last follow-up. Nineteen patients (47.5%) remained stable with Y-BOCS of 33 (range, 26-36) following GVC, whereas 3 patients (7.5%) experienced worsening in Y-BOCS scores. Patients treated with 2 isocenters were more likely to have improvement in Y-BOCS score at 3 and 5 yr (P < .0005). Ten patients (25%) experienced post-GVC mood disturbance and neurological complications in 3 patients (7.5%). One patient developed radiation necrosis with edema that improved with steroids. CONCLUSION GVC serves as a reasonable treatment strategy for severe medical refractory OCD. Patients treated with 2 isocenters were more likely to have substantial improvement in OCD.
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Affiliation(s)
- Amitabh Gupta
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Matthew J Shepard
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Tanmoy Maiti
- Cleveland Clinic, Department of Neurological Surgery, Cleveland, Ohio
| | - Nuria Martinez-Moreno
- Department of Functional Neurosurgery and Radiosurgery, Ruber International Hospital, Madrid, Spain
| | - Joshua Silverman
- Department of Radiation Oncology, NYU Langone Health System, New York, New York
| | - Christian Iorio-Morin
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS Sherbrooke, Québec, Canada
| | - Roberto Martinez-Alvarez
- Department of Functional Neurosurgery and Radiosurgery, Ruber International Hospital, Madrid, Spain
| | - Gene Barnett
- Cleveland Clinic, Department of Neurological Surgery, Cleveland, Ohio
| | - David Mathieu
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS Sherbrooke, Québec, Canada
| | | | - Douglas Kondziolka
- Department of Radiation Oncology, NYU Langone Health System, New York, New York.,Department of Neurosurgery, NYU Langone Health System, New York, New York
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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13
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Gong F, Li B, Zhang S, Wang Y, Gao Y, Xu Y, Wang X, Xiong B, Li D, Wen R, Qin Z, Wang W. The Suitability of Different Subtypes and Dimensions of Obsessive-Compulsive Disorder for Treatment with Anterior Capsulotomy: A Long-Term Follow-Up Study. Stereotact Funct Neurosurg 2019; 97:319-336. [DOI: 10.1159/000500137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/03/2019] [Indexed: 11/19/2022]
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14
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Balachander S, Arumugham SS, Srinivas D. Ablative neurosurgery and deep brain stimulation for obsessive-compulsive disorder. Indian J Psychiatry 2019; 61:S77-S84. [PMID: 30745680 PMCID: PMC6343416 DOI: 10.4103/psychiatry.indianjpsychiatry_523_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Despite advancements in pharmacotherapeutic and behavioral interventions, a substantial proportion of patients with obsessive-compulsive disorder (OCD) continue to have disabling and treatment-refractory illness. Neurosurgical interventions, including ablative procedures and deep brain stimulation (DBS), have emerged as potential treatment options in this population. We review the recent literature on contemporary surgical options for OCD, focusing on clinical aspects such as patient selection, presurgical assessment, and safety and effectiveness of these procedures. Given the invasiveness and limited evidence, these procedures have been performed in carefully selected patients with severe, chronic, and treatment-refractory illness. Along with informed consent, an independent review by a multidisciplinary team is mandated in many centers. Both ablative procedures and DBS have been found to be helpful in around half the patients, with improvement observed months after the procedure. Various targets have been proposed for either procedure, based on the dominant corticostriatal model of OCD. There is no strong evidence to recommend one procedure over the other. Hence, the choice of procedure is often based on the factors such as affordability, expertise, and reversibility of adverse effects. Surgery is not recommended as a standalone treatment but should be provided as part of a comprehensive package including medications and psychotherapeutic interventions. Available evidence suggest that the benefits of the procedure outweigh the risks in a treatment-refractory population. Advances in neurosurgical techniques and increasing knowledge of neurobiology are likely to bring about further progress in the efficacy, safety, and acceptability of the procedures.
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Affiliation(s)
- Srinivas Balachander
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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15
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Zhang C, Li D, Lin G, Sun B. In Reply: Long-Term Follow-up Study of MRI-Guided Bilateral Anterior Capsulotomy in Patients With Refractory Anorexia Nervosa. Neurosurgery 2018; 83:E41-E42. [PMID: 29912441 DOI: 10.1093/neuros/nyy124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chencheng Zhang
- Department of Functional Neurosurgery Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Dianyou Li
- Department of Functional Neurosurgery Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Guozhen Lin
- Department of Psychiatry Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Bomin Sun
- Department of Functional Neurosurgery Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai, China
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16
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Zhang C, Chen Y, Tian S, Wang T, Xie Y, Jin H, Lin G, Gong H, Zeljic K, Sun B, Yang T, Zhan S. Effects of Anterior Capsulotomy on Decision Making in Patients with Refractory Obsessive-Compulsive Disorder. Front Psychol 2017; 8:1814. [PMID: 29089909 PMCID: PMC5651033 DOI: 10.3389/fpsyg.2017.01814] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 09/29/2017] [Indexed: 12/05/2022] Open
Abstract
Despite various lines of evidence implicating impaired decision-making ability in individuals with obsessive–compulsive disorder (OCD), neuropsychological investigation has generated inconsistent findings. Although the cortico-striato-thalamo-cortical (CSTC) circuitry has been suggested, the involvement of the cortex has not yet been fully demonstrated. Moreover, it is unknown whether surgical intervention on the CSTC circuitry results in a predicted improvement of decision-making ability of OCD. Here we present a study of decision making based on the Iowa Gambling Task (IGT) to investigate decision making in a large sample of individuals with treatment-resistant OCD with and without anterior capsulotomy (AC). Task performance was evaluated in healthy subjects, individuals with OCD that had not undergone surgery, and postsurgical OCD patients with AC. The latter group was further divided into a short-term postsurgical group and a long-term postsurgical group. We found that the OCD patients without surgery performed significantly worse than the healthy controls on the IGT. There were no significant differences in decision-making between the presurgical OCD patients and those at the short-term postsurgical follow-up. Decision-making ability of the long-term postsurgical OCD patients was improved to the level comparable to that of healthy controls. All clinical symptoms (OCD, depression, and anxiety) assessed by psychiatric rating scales were significantly alleviated post-surgically, but exhibited no correlation with their IGT task performance. Our findings provide strong evidence that OCD is linked to impairments in decision-making ability; that impaired CSTC circuitry function is directly involved in the manifestation of OCD; and that AC related improvements in cognitive functions are caused by long-term plasticity in the brain circuitry.
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Affiliation(s)
- Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yilin Chen
- Institute of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Shuaiwei Tian
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yile Xie
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Jin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guozhen Lin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hengfen Gong
- Department of Psychiatry, Pudong District Mental Health Center, Shanghai, China
| | - Kristina Zeljic
- Institute of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianming Yang
- Institute of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Shikun Zhan
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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